Hospice public policy priorities for 2024

Hospices are asking lawmakers and regulators to take action to reduce fraud, support veterans and strengthen the health care workforce.

A group of hospice leaders recently participated in Hospice Action Week, a lobbying event organized last week by the National Hospice and Palliative Care Organization (NHPCO) and the Hospice Action Network. During meetings with legislators, suppliers presented their policy priorities.

According to NHPCO Chief Operating Officer and Interim CEO Ben Marcantonio, a key goal of these discussions was to establish open lines of communication with congressional offices to support continued advocacy for hospice issues.

“The biggest priority is for the advocates that are here to establish or strengthen the relationships that they have and that we have as a hospice community across the country, with congressional leaders,” Marcantonio told Hospice News. “Through this connection, they will be able to identify the one or two issues that are most relevant to them and really share their perspective, share the stories that are related to that.”

Among the myriad issues affecting this space, several initiatives have surfaced.

Fight against fraud

Reports of unethical or illegal practices have increased, particularly among hundreds of newly certified hospices in California, Texas, Nevada and Arizona. Recent evidence shows that more and more of these providers are enrolling in the Medicare program despite past efforts by the U.S. Centers for Medicare and Medicaid Services (CMS) to reduce fraud and abuse.

Some of these providers started out by providing substandard care to a few patients and then sold their hospices or licenses.

So far, California is the only state to take action on hospice fraud, prompting some dishonest providers to set up operations in other states, such as Nevada.

“The biggest thing that’s top of mind for me is the scammers,” Lynne Sexten, CEO of Wisconsin-based Agrace Hospice, said in an interview with Hospice News. “We’re watching very closely to see if bad actors start to emerge in my state, working closely with the Wisconsin Department of Health, making sure they’re vigilant and understand what’s happening in other states.”

Some lawmakers have been open to moves to tax bogus hospices with excise taxes. Recently, Rep. Beth Van Duyne (R-Texas) called for a crackdown on the organizations.

Additionally, Democratic Rep. Earl Blumenaur (Oregon) is working on a bill to address fraud and improve the quality of hospice care.

Blumenauer announced the Hospice Care Accountability, Reform, and Enforcement Act (Hospice CARE) at the Hospice News Elevate conference in Washington, D.C. While the bill is still in the development phase, key provisions are likely to include a new payment mechanism for high-intensity palliative care, changes to per diem payments and patient certification processes, and other provisions.

To date, efforts to combat hospice fraud have received bipartisan support.

“When you start breaking down health care in general, there’s a lot more bipartisan work. These are not partisan issues,” Van Duyne told Hospice News. “I think if we look at the overall laws that burden our health care providers, we should be on the same page on this.”

Gerald’s Law

Hospice providers and industry groups are also pushing for the passage of “Gerald’s Law,” intended to close a legal loophole that negatively impacts veterans.

When eligible veterans die, many of their families are eligible for a financial benefit from the U.S. Department of Veterans Affairs (VA) to cover part of the costs of funerals and cremations or burials. However, when a veteran moves from a VA facility to a hospice facility, they lose access to this benefit. This is true even if the VA itself provides hospice care.

Rep. Jack Bergman (R-Michigan) first proposed the bill with co-sponsor Rep. Colin Allred (D-Texas).

“Gerald’s Law is a great piece of legislation. It’s one of those bills that you look at and say, ‘What’s the problem?’ Passing legislation is complicated and sometimes there are some oversights, and this certainly wasn’t something that was done intentionally,” Logan Hoover, vice president of health policy and government relations at NHPCO, told Hospice News. “It’s a really great bill to support because it’s good policy and good politics. But it also gives us an opportunity to talk to members of Congress who sit on the Veterans Affairs Committee who may not be as familiar with hospice.”

The bill’s language has since been incorporated into a larger piece of legislation, Senator Elizabeth Dole’s 21st Century Veterans Health Care and Benefits Improvement Act. The omnibus bill, introduced in the House in late May, aims to reform various aspects of VA health care, including access to mental health services and more home- and community-based services.

“Growing up in a military family, Gerald’s Law is close to my heart,” Kim Olson, chief compliance officer at St. Hospice, told Hospice News in an email. Croix. “This would allow veterans to have access to full burial and funeral benefits while receiving VA care outside of a VA facility. This law would allow veterans to choose the location of care they want based on comfort, not cost.”

Rebuilding the workforce

Hospices are also demanding action under the Palliative Care and Hospice Training Act (PCHETA).

If enacted into law, PCHETA would authorize $100 million over five years to support programs designed to strengthen clinical education in hospice and palliative care, as well as related interdisciplinary professions such as chaplaincy, pharmacy and social work.

The legislation would establish fellowships within new palliative care and hospice facilities to provide short-term, intensive training, as well as motivational award programs in all relevant disciplines, and would also support programs to develop career paths in the field.

The PCHETA Act was first introduced in 2017 and again in 2019. The U.S. House of Representatives approved the bill twice, but it stalled in the Senate — despite the support of nearly 300 bipartisan cosponsors on the second try.

Meaning. Tammy Baldwin (D-Wisc.) and Shelley Moore Capito (RW.Va.) revived PCHETA in 2022 and again in July 2023, but the bill has not yet passed. Nevertheless, senators pledged to continue their efforts to implement the bill.

“Senator Baldwin and I are committed to seeing this bill through to the end so that the next generation of hospice and palliative care providers can be trained,” Moore Capito told Hospice News. “As someone whose loved ones have benefited from hospice and palliative care, I know how important this care is for both the patient receiving care and his family. “Unfortunately, like many other areas of health care, hospices are experiencing staffing shortages and I am concerned that this may impact the ability of patients and families to access this important type of care.”

The bill received the support of over 50 industry organizations. These include the National Association for Home Care & Hospice (NAHC), NHPCO, Hospice Action Network, Hospice and Palliative Nurses Association, and the American Academy of Hospice and Palliative Medicine, among others.

“I remain hopeful that we will be able to cross the finish line. But in this political environment, even simple, common sense things are difficult,” Hoover said. “Even bilateral issues are difficult, so there will be headwinds this fall.”

Revision of the special program

CMS introduced a hospice focus program (SFP) in its 2024 home health payment rule, which included several provisions specific to hospices. The program began implementation on January 1.

While the hospice community has generally expressed support for the program, many say the agency’s methodology for identifying hospices for SFPs is deeply flawed. Stakeholders, including hospice providers and members of Congress, have called on CMS to postpone the program and change the algorithm.

“We fully support a ratings system that will help better inform families when choosing service providers,” Olson said. “Due to the way data is collected (or specifically excluded), we believe the system currently proposed will not provide a clear picture of quality.”

Congress mandated SFP in the Consolidated Appropriations Act of 2021, which included a provision from the Helping Our Senior Population in Comfort Environments (HOSPICE) Act. This was in response to July 2019 reports on hospice quality from the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS).

The program will have the authority to impose enforcement measures on poorly performing hospices based on its algorithm. Hospices identified by the SFP will also be reviewed every six months, instead of every three years as they currently are, and could face fines or exclusion from Medicare.

“There are significant algorithm flaws in the Hospice SFP, not the least of which is that you can be excluded from the calculation simply by not submitting data,” Olson pointed out. “Additionally, we believe that with minor tweaks, government audit resources could be better allocated to catching truly fraudulent and poorly performing entities.”